NEW YORK (Reuters Health) Aug 19 - Up to 15% of patients with rheumatoid arthritis who were treated with conventional therapy in Dutch and British cohort studies had symptom remission for at least a year, according to a report in the August issue of Arthritis and Rheumatism.
Non-steroidal anti-inflammatory drugs (NSAIDs) and non-biologic disease-modifying antirheumatic drugs (DMARDs) were considered to be conventional therapy.
The authors of the report, led by Dr. Diane van der Woude of Leiden University Medical Center, the Netherlands, point out that the introduction of biologic antirheumatic drugs has led to an increase in the number of research trials reporting remission as an outcome. This led them to investigate achievement of remission with conventional treatment.
"Rheumatoid arthritis is always thought of as a chronic disease which will not go away unless treated very aggressively," Dr. van der Woude told Reuters Health by e-mail. "Our findings now show that, even in the 'pre-biologics era,' 9-15% of the patients actually got rid of their disease, a quite substantial number that we had not expected."
The research team analyzed data from two independent cohort studies, one from the Netherlands and one from the UK, conducted in patients whose RA symptoms had begun less than two years before enrollment.
The Dutch cohort ran from 1993 to 2002 and comprised 454 patients. Initial treatment evolved over that time but included analgesics followed as needed by hydroxychloroquine or sulfasalazine, initial chloroquine or sulfasalazine, and, later, methotrexate or sulfasalazine.
The British cohort consisted of 895 patients recruited through nine rheumatology departments in the UK between 1986 and 1996. Treatment was at the discretion of the patient's rheumatologist but was typically a short course of analgesics followed, if needed, by monotherapy or combination therapy with methotrexate, sulfasalazine and hydroxychloroquine.
Sustained disease-free remission was defined as no current use of DMARDs, no swollen joints for at least a year, and classification as DMARD-free remission by the patient's rheumatologist.
Sustained remission by this standard was achieved by 68 (15.0%) of the Dutch patients and 84 (9.4%) of the UK. patients.
Factors that predicted sustained remission in both cohorts included acute onset, shorter duration of symptoms before study entry, not smoking, little radiographic damage at baseline, absence of IgM rheumatoid factor, and absence of HLA shared epitope alleles.
Independent predictors on multivariate analysis were symptom duration and the absence of autoantibodies.
Arthritis Rheum 2009;60:2262-2271.